Basic Information
| Provider Information | |||||||||
| NPI: | 1245456938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH-KLINGBEIL | ||||||||
| OtherFirstName: | RACHAEL | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 405827 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709345871 | ||||||||
| FaxNumber: | 8709345850 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 SOUTHCREST PARKWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627722488 | ||||||||
| FaxNumber: | 6627723102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD0000041900 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MD0000041900 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 21789 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 41900 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.